RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / Ms. MATILDA SUDARSANAN,
M.Sc. NURSING 1st YEAR,
WOCKHARDT INSTITUTE OF NURSING,
# 20/5, YELACHENAHALLI,
KANAKAPURA MAIN ROAD,
BANGALORE- 560078
2 / NAME OF THE INSTITUTION / WOCKHARDT INSTITUTE OF NURSING, BANGALORE- 560078
3 / COURSE OF STUDY AND SUBJECT / M.Sc. NURSING 1st YEAR,
OBSTETRIC AND GYNAECOLOGICAL NURSING.
4 / DATE OF ADMISSION TO THE COURSE / 31-10-2009
5 / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME ON KNOWLEDGE REGARDING NEWBORN CARE AMONG PRIMIPARA MOTHERS IN SELECTED HOSPITALS, BANGALORE.”

INTRODUCTION:

“There is one order of beauty which seems made to turn heads. It is a beauty like that of kittens, or very small downy ducks making gentle rippling noises with their soft bills, or babies just beginning to toddle.”

------T.S. Eliot

The birth of a baby is a momentous occasion: tiny details of experiences surrounding the whole event are etched in memory forever. Care during childbirth are those essential but unmeasureable components of care that count even though they cannot be counted: the empathy and judgement that permits care to be personalized for each woman and her family 1.

The knowledge of care of newborn is essential for a primipara mother. She has to prepare herself for proper care of the newborn. The care of newborn begins with bathing, clothing, feeding, positioning and care of umbilical cord of the baby etc. The mothers need to be well versed with it for proper handling of the baby.

The period from birth to 28 days of life is called neonatal period and the infant in this period is termed as neonate or newborn baby. The healthy newborn at term, between 38 to 42 weeks, cries immediately after birth, establishes independent rhythmic respiration, quickly adapts with extra uterine environment 2.

But healthy survival of the baby is threatened every moment. Baby’s health problems are shocking and alarming throughout the world, especially in the developed countries. Expert and empathetic approach is essential to minimise these problems and to reduce the inexcusable causes of neonatal morbidity, mortality and disability 2.

Essential care of the normal healthy newborn can be best provided by mothers. Almost 80 percent of the newborn babies require minimal care. The normal term baby should be kept with their mothers rather than in a separate nursery. Bedding-in or rooming-in promotes emotional bondage, prevents cross-infection and establishes breastfeeding easily. Mother participates in the nursing care of the baby and develops self-confidence in her 2.

The major goal of newborn care is to establish homeostasis (i.e. stability in the normal physiological status). Continuous care has to be provided immediately following birth, in the transition period and during the neonatal period. This care is performed involving mother and family members. Majority of the complications of the normal neonates may occur during first 24 hours or within 7 days. So close observations and daily essential routine care are important for health and survival of newborn baby 2.

Warmth has to be provided by keeping the baby dry and wrapping the baby with adequate clothing in two layers, ensuring head and extremities are well-covered. Baby should be kept by the side of the mother, so that the mother’s body temperature can keep the baby warm. Baby can be placed in skin to skin contact with mother (kangarooing) to maintain temperature of infant and facilitate breastfeeding. Bathing is avoided to prevent hypothermia and infections. Ambient atmospheric temperature to be kept warm adequately (28-320C). Warmth to be maintained during transfer from hospital to home on discharge or whenever needed and necessary exposure or undressing to be avoided. The oil massage is both culturally and scientifically acceptable as it provides insulation against heat and prevents insensible water loss 2.

While some new parents are lucky enough to have a friend, relative or paid care taker to help them with the baby’s care, most are not. They have to face the responsibility alone. It is often a memorable experience for a couple to be parents of a first baby. To avoid being unprepared, parents-to-be should try to take a course in infant care. Such a course is offered by the prenatal clinics of most hospitals and is open to anyone who wants to enrol 3.

6.0 A BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY:

Most of newborn problems occur due to inadequate care during the antenatal period and during labour. Inadequate care immediately after birth and inadequate care of LBW infants within the first 48 hours contribute to the rest. Although a significant proportion of women would be categorized as high-risk and identified for institutional delivery, yet over 75% of all births take place in the community and mostly in the hands of unskilled birth attendants with little postpartum care to either the mother or the newborn. Clearly, the intervention package must focus not only on the newborn alone but treat the mother–baby as one 4.

Many a times the cultural practices may also cause problems. The practices like bathing the newborn soon after birth may cause a change in the thermoregulation of the baby. It is essential for the mother and others to know about the time of bathing for regulating thermoregulation. Many mothers do not know the essentialities of skin to skin care i.e. Kangaroo Mother Care. It also plays a very important role in maintaining the thermoregulation of the baby. The baby is more attached to his/her parents. This teaching is very essential.

In India the mortality rate in the age group of 0–28 days is about 39/1000 live-births, 1–12 months about 30/1000 live-births and 1–5 years about 26/1000 live-births. Thus, the ratio of neonatal death rate to 1–5-year death rate is about 1.3. In contrast, in most developed countries the ratio is over 10. Thus, efforts are under way to reduce neonatal mortality in India, by introducing information, education and communication programme 4.

A review of ages at death during the first 28 days reveals that two-thirds of deaths occur in the first week of life and two-thirds of these within the first 2 days of life (Baseline surveys of Multi-centric Home based Intervention project of the Indian Council of Medical Research [ICMR]. Thus, almost 45% of neonatal deaths take place within 48 hours of birth. The major causes of death during this period are birth asphyxia and trauma, problems related to low birth weight (such as hypothermia, respiratory problems, feeding and peripartum infections) and malformations4.

A study in Uttar Pradesh, India demonstrated a 50 percent decline in neonatal mortality through raising awareness in the community of such simple survival strategies as cleaning, drying and warming the newborn, skin-to-skin contact with the mother, and exclusive breastfeeding for the first six months 5.

Every Five Minutes, a New Born Baby Dies in Bihar (India). If statistics available with Dept. of Health, Govt. of Bihar are to be believed, in everyfive minutes, a new born baby dies here due to the lack of understanding of the science and art of reception of a new life into this world.Patna Medical College Hospital at Patna, itself receives each day a new born-dead baby having expired enroute, due to improper transportation. In Bihar, about 80% births take place at home and 10% in private nursing homes, where insufficient facilities for neonatal resuscitation are available. The rest, about 10% take place in well managed hospitals. These sick babies were invariably wrapped up in dirty cloth and sent to Higher Medical Centre without proper stabilisation of airways, maintenance of body temperature and blood sugar 6.

According to UNICEF State of the World’s Children 2009 26% of neonatal death is due to neonatal sepsis,27% is due to preterm, 23% is due to asphyxia, 7% is due to tetanus, 3% is due to diarrhoeal diseases, 7% is due to congenital diseases 7% is due to others. As on 9th March, 2010 4 million children die within first 24 hours across the world out of which India records 1 million cases 7.

A study was conducted to know the factors associated with maternal knowledge of newborn among 446 hospital delivered mothers newborn pairs in Puttalam district of Srilanka. Data was collected by using a questionnaire. According to multivariate analysis, primipara (odd ratio [OR] = 2.31; 95% CI= 1.53-3.50), unemployed women (OR= 3.31; 95% CI=1.89-5.80) and those with delayed antenatal booking visits (OR= 2.02; 95% CI 1.26-2.23) were more likely to have poor knowledge. In conclusion mothers had a satisfactory knowledge about breast feeding and recognition of danger signs, but knowledge about care of umbilical cord was poor 8.

A 217 household survey was conducted to know newborn care practices in rural Egypt during the first weeks of life. The result showed that nearly half (43%) of the mothers reported that they did not wash their hands before neonatal care and only 7% washed hands after changing diaper. Thermal control was not practiced, although mothers perceived 22% of newborns to be hypothermic. The practices observed which are critical for newborn survival could be improved with minor modifications 9.

All these studies have shown that, most primipara mothers lack the knowledge on newborn care so teaching to primipara mothers about newborn care is essential. In present world media plays a important role. People find it easy to see and learn rather than only to read information.Video assisted teaching about newborn care may contribute to greater care, knowledge and maternal confidence.

Hence the investigator finds it is essential to give a video assisted teaching programme to primipara mothers regarding newborn care. Thus to improve the overall quality of life and to reduce the infant mortality rate it is essential to improve the new born care. Education for this should be given to the mother at the postnatal period for proper care of the baby.

6.2 REVIEW OF THE LITERATURE:

Review of literature for the present study has been organised under the following headings.

6.2.1 Literature related to knowledge on neonatal care.

6.2.2 Literature related to video assisted teaching programme

6.2.1 Literature related to knowledge on neonatal care:

A study was conducted on knowledge of mothers regarding newborn care practices in urban slums in Delhi. Community based cross sectional survey was done on 82 mothers of which more than half i.e. 46 (56.1%) were home deliveries. Bathing the baby immediately after birth was commonly practiced in 38 (82.6%) of home deliveries. Finger was used to clean the air passages in most of the home deliveries (29.63%). It indicates that there is an urgent need to reorient health care providers and to educate mothers on clean delivery practices and early newborn care 10.

A study was conducted on knowledge of mothers regarding newborn care practices during childbirth and postnatal period: a comparison of three rural districts in Bangladesh. 6785 women were interviewed. The mothers reported few key hygienic practices in 54% of deliveries: attendants washing their hands with soap and boiling the cord tie and blade for cutting the cord, 42% of the 6785 infants were given bath immediately after delivery and 42% were given colostrum as their first food. The results suggest that newborn care practices are not good in rural Bangladesh it needs to be improved 11.

A study was conducted to assess the knowledge, attitude and practice of 22 mothers in age group of 23-34 years and 33staff nurses at neonatal postnatal and paediatric wards of AIMMS NewDelhi. Mothers had reservations about practicing KMC effectively due to lack of privacy (40%), post operative pain (10%) and tiredness (5%). The responses given were improved by giving counselling to mothers and family members (45.5%) and by giving health education to mothers (21.2%). It is concluded that mothers should be motivated for KMC while their stay in hospitals by staff nurses 12.

A study was conducted to know the impact of newborn bathing on the prevalence of neonatal hypothermia in Uganda. A randomised controlled trial method was used on asphyxiated newborns after vaginal delivery (n =249) in a referral hospital were controlled and randomized either to bathing at 60 minutes postpartum (n=126) or no bathing (n=123).Bathing newborn babies shortly after birth increased risk of hypothermia despite the use of warm water and skin to skin care for thermal protection of newborn 13.

A study was conducted on diaper rash. A baby born at 39 wks of gestation via normal delivery with the assistance of midwife had a severe diaper rash mare than a week. On admission the patient was treated with application of 5cc breast milk. Using a sterilized hand held breast pump to the denuded areas. Infant went without a diaper for 20 minutes to help dry up the diaper rash. The mother cleaned the genital area of the baby by washing hands and using pure water and cotton. The case revealed that care of evasive diaper rash by applying breast milk fully recovered in 7-8 days 14.

A study was conducted on breast feeding and effects on normal birth weight babies in Srilanka. A purposive sample of 100 mothers having 6 months old babies who had normal birth weight ant brought to well baby clinic was used. Out of 70% exclusively breastfed babies 6% had diarrhoea and 8% had respiratory infections. Out of 28% who were not exclusively breastfed 15% had diarrhoea and 12% had respiratory infections. Weight gain chart indicated that exclusively breastfed babies had 85% normal gain and 15% had less. They concluded that mothers should be educated and encouraged to continue breastfeeding 15.